1446 https://oamjms.eu/index.php/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2022 Nov 12; 10(B):1446-1449. https://doi.org/10.3889/oamjms.2022.9983 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Gynecology and Obstetrics Risk Factors That Correlate with Resistance to First-Line Chemotherapy on High-risk Gestational Trophoblastic Neoplasia Andi Kurniadi , Zulvayanti Zulvayanti , Dodi Suardi , Kemala Mantilidewi , Bayu Indrayana Irsyad , Arnova Reswari , Benny Hasan Purwara , Gatot Nyarumenteng Adhipurnawan Winarno* Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital Bandung, West Java, Indonesia Abstract BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a condition arising from abnormal proliferation of the trophoblastic cells. GTN incidence in Indonesia, precisely in Hasan Sadikin General Hospital, as many as 730 cases are reported per year. GTN is generally highly sensitive to chemotherapy, and multiagent chemotherapy regimens are recommended for high-risk GTN. Multiagent chemotherapy regimens for GTN treatment at Hasan Sadikin General Hospital are EMCO, with no other literature study describing chemotherapy resistance with EMCO today. AIM: This study aimed to identify risk factors associated with frst-line chemotherapy resistance at Hasan Sadikin General Hospital. METHODS: In this cross-sectional study, medical records of 81 patients with high-risk GTN presented in the period from January 2018 to June 2021 who received EMCO chemotherapy at Hasan Sadikin General Hospital were retrieved from the archives, and medical data were reviewed and analyzed. Bivariate analysis was performed using the Chi-square test with Fisher’s exact alternative, and multivariate analysis using the binary logistic regression test. p < 0.05 was considered statistically signifcant. RESULTS: From 81 samples that received EMCO chemotherapy, 15 (18.5%) cases were resistant to EMCO, and 66 (81.5%) cases were responsive to EMCO. The risk factors associated with EMCO resistance were histopathological features and appropriate with EMCO chemotherapy interval (p < 0.05). Variables of age, previous pregnancy, GTN stage, FIGO prognostic score, stage, beta-hCG level, and side efects of EMCO did not signifcantly correlate with resistance to EMCO (p > 0.05). CONCLUSION: Histopathological features and appropriate chemotherapy intervals were associated with the incidence of resistance to EMCO in Hasan Sadikin General Hospital. Edited by: Ksenija Bogoeva-Kostovska Citation: Kurniadi A, Zulvayanti Z, Suardi D, Mantilidewi K, Irsyad BI, Reswari A, Purwara BH, Nyarumenteng Adhipurnawan Winarno GNA. Risk Factors That Correlate with Resistance to First-Line Chemotherapy on High-risk Gestational Trophoblastic Neoplasia. Open Access Maced J Med Sci. 2022 Nov 12; 10(B):1446-1449.https://doi.org/10.3889/oamjms.2022.9983 Keywords: High-risk gestational trophoblastic neoplasia; EMCO; Chemotherapy resistance *Correspondence: Gatot Nyarumenteng Adhipurnawan Winarno, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital Bandung, West Java, Indonesia 40161. E-mail: gatot.nyarumenteng@unpad.ac.id Received: 27-Apr-2022 Revised: 28-Oct-2022 Accepted: 02-Nov-2022 Copyright: © 2022 Andi Kurniadi, Zulvayanti Zulvayanti, Dodi Suardi, Kemala Mantilidewi, Bayu Indrayana Irsyad, Arnova Reswari, Benny Hasan Purwara, Gatot Nyarumenteng Adhipurnawan Winarno Funding: This study was supported by institutional grant from Universitas Padjajaran No. 1959/UN6.3.1/PT.00/2021 Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Gestational trophoblastic neoplasia (GTN) is a type of gestational disease group of pregnancy- related malignancies [1]. GTN incidence in developed countries is approximated to be one case per 40,000 pregnancies; meanwhile, in Indonesia, precisely in Hasan Sadikin General Hospital, as many as 730 cases are reported per year [2], [3]. GTN is generally highly sensitive to chemotherapy with a high cure rate of up to 90−100% [2], [4], [5]. Chemotherapy options depend on the risk classifcation according to the International Federation of Gynecology and Obstetrics (FIGO) prognosis scoring system. Multiagent chemotherapy regimens are recommended for high-risk GTN; by defnition is GTN with a FIGO prognosis score of ≥ 7. The survival rate of high- risk GTN patients treated with multiagent chemotherapy regimens is higher than that of single-agent regimens (65−70% vs. 14−39%, respectively) [2]. Etoposide, Methotrexate, Actinomycin-D, Cyclophosphamide, and Vincristine (EMA-CO) are the frst-line chemotherapy regimens for high-risk GTN, with a remission rate of 90.6% [2], [6], [7]. In addition to EMA-CO, EMA-EP (Etoposide, Methotrexate, Actinomycin-D, Etoposide, and Cisplatin) is also reported as a second-line chemotherapy regimen with a remission rate of up to 82% [4]. A retrospective study in Korea examined the efcacy of multiagent chemotherapy regimens in 227 high-risk GTN patients. The study showed that EMA-CO had the highest remission rate and required fewer chemotherapy cycles for remission compared to other multiagency regimens. Remission rates for the other chemotherapy regimens are 63.3%, 67.5%, and 76.2% for MFA (Methotrexate, Folinic acid, and Actinomycin-D), MAC (Methotrexate, Actinomycin-D, and Cyclophosphamide), and CHAMOCA (Cyclophosphamide, Hydroxyurea, Doxorubicin, Actinomycin-D, Methotrexate, Melphalan, and Vinstine), respectively [2]. After molar evacuation, patients should be monitored with weekly determinations of a-subunit hCG levels until these levels are normal for three consecutive weeks, followed by monthly determinations until the Since 2002